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Background
To evaluate optimal therapy and potential risk factors.
Methods
Data of DSRCT patients <40 years treated in prospective CWS trials 1997-2015 were analyzed.
Results
Median age of 60 patients was 14.5 years. Male:female ratio was 4:1. Tumors were abdominal/retroperitoneal in 56/60 (93%). 6/60 (10%) presented with a localized mass, 16/60 (27%) regionally disseminated nodes, and 38/60 (63%) with extraperitoneal metastases. At diagnosis, 23/60 (38%) patients had effusions, 4/60 (7%) a thrombosis, and 37/54 (69%) elevated CRP. 40/60 (67%) patients underwent tumor resection, 21/60 (35%) macroscopically complete. 37/60 (62%) received chemotherapy according to CEVAIE (ifosfamide, vincristine, actinomycin D, carboplatin, epirubicin, etoposide), 15/60 (25%) VAIA (ifosfamide, vincristine, adriamycin, actinomycin D) and, 5/60 (8%) P6 (cyclophosphamide, doxorubicin, vincristine, ifosfamide, etoposide). Nine received high-dose chemotherapy, 6 received regional hyperthermia, and 20 received radiotherapy. Among 25 patients achieving complete remission, 18 (72%) received metronomic therapies. Three-year event-free (EFS) and overall survival (OS) were 11% (±8 confidence interval [CI] 95%) and 30% (±12 CI 95%), respectively, for all patients and 26.7% (±18.0 CI 95%) and 56.9% (±20.4 CI 95%) for 25 patients achieving remission. Extra-abdominal site, localized disease, no effusion or ascites only, absence of thrombosis, normal CRP, complete tumor resection, and chemotherapy with VAIA correlated with EFS in univariate analysis. In multivariate analysis, significant factors were no thrombosis and chemotherapy with VAIA. In patients achieving complete remission, metronomic therapy with cyclophosphamide/vinblastine correlated with prolonged time to relapse.
Conclusion
Pleural effusions, venous thrombosis, and CRP elevation were identified as potential risk factors. The VAIA scheme showed best outcome. Maintenance therapy should be investigated further.
The strategic planning of Emergency Medical Service systems is directly related to the probability of surviving of the affected humans. Academic research has contributed to the evaluation of these systems by defining a variety of key performance metrics. The average response time, the workload of the system, several waiting time parameters as well as the fraction of demand that cannot immediately be served are among the most important examples. The Hypercube Queueing Model is one of the most applied models in this field. Due to its theoretical background and the implied high computational times, the Hypercube Queueing Model has only been recently used for the optimization of Emergency Medical Service systems. Likewise, only a few system performance metrics were calculated with the help of the model and the full potential therefore has not yet been reached. Most of the existing studies in the field of optimization with the help of a Hypercube Queueing Model apply the expected response time of the system as their objective function. While it leads to oftentimes balanced system configurations, other influencing factors were identified. The embedding of the Hypercube Queueing Model in the Robust Optimization as well as the Robust Goal Programming intended to offer a more holistic view through the use of different day times. It was shown that the behavior of Emergency Medical Service systems as well as the corresponding parameters are highly subjective to them. The analysis and optimization of such systems should therefore consider the different distributions of the demand, with regard to their quantity and location, in order to derive a holistic basis for the decision-making.